Clínicas Perinatológicas Argentinas 2019-2020 / Argentine perinatological clinics 2019-2020

Número que reúne material del curso a distancia Clínicas Perinatológicas Argentinas 201-2020, desarrollado por la Asociación Argentina de Perinatología.

Clínicas Perinatológicas Argentinas 2018 / Argentine perinatological clinics 2018

En este número se reúne material sobre perinatología preventiva; dolor del músculo esquelético durante el embarazo; seguimiento del recién nacido de alto riesgo; hiperemesis gravídica; drogas y embarazo; microbioma y epigenética en perinatología; duelo perinatal; y cuidado del recién nacido.

Clínicas Perinatológicas Argentinas 2017 / Argentine Perinatologics Clinics 2017

En este número se reúne material sobre actualidad de la medicina perinatal, psicología perinatal, trato obstétrico inadecuado, y etiología de la rotura prematura de membranas durante el embarazo.

Instructivo para el registro de datos de la historia clínica materno perinatal / Instructions for registration of data on maternal and perinatal history

La presente publicación es un documento médico legal, que describe la metodología de registro de datos en forma sistemática, expresados tanto por la persona que padece un proceso mórbido, como los observados por el examinador. Está constituodo en cuatro partes: En la primera parte se presenta la filiación, antecedentes y datos basales del paciente. En la segunda parte se presentan los espacios respectivos para el registro de los controles prenatalaes. En la tercera, de cuatro secciones, referida a parto/aborto, recién nacido, puerperioy un listado de las principales patologías relacionadas con el recién nacido. Finalmente,la última parte de cuatro secciones: Egresos y reingresos, indicaciones al alta, epicrisis y un listado con los códigos de las indicaciones principales de parto operatorio o inducción y la mediación con sus respectivos medicamentos. Incluye la Historia clínica Materno Perinatal y el Carné de Control Materno Perinatal

[Computer-assisted cardiotocogram analysis--from descriptive to perinatal expert system]. / Die computergestützte Kardiotokographieanalyse--Von der Deskription zum perinatologischen Expertensystem.

The interpretation of cardiotocograms is essentially for perinatal management, it remains labour intensive and depends on training and experience. With the development of modern analysing systems with conventional classification techniques, it seems possible to introduce expert systems and neuronal networks for a better interpretation and classification of cardiotocograms. Techniques of artificial intelligence are powerful tools and should be integrated in future systems. Because CTG-analysis--as a single procedure--is only of limited value for sufficient fetal prognosis, we conclude that computer aided CTG-analysis in combination with additional fetal parameters, for example partial oxygen pressure, will allow the development of future sufficient perinatal expert systems. Nothing should hinder future integration of computerized cardiotocogram analysing systems into everyday clinical routine and to connect it to obstetrical databases.

Thirty years of fetal and neonatal physiologic measurements. Have they made a difference?

In looking at fetal and neonatal measurement technology as covered in this issue and as reported in areas not covered in this issue, we need to ask the question: Has this technology made a difference? Unfortunately, the answer is not clear. There are cases where the answer is a solid "yes" and other cases where "maybe" is the best we can say at the present time. There are also a few examples where even though noble attempts have been made, the answer must be "no." What does this mean in terms of what needs to be done? We certainly need to continue the development of new measurement technology and to carry out this development based on sound physiologic and engineering principles. We need to understand better the physical and biologic basis of the measurements that we make and to perform carefully controlled clinical trials of technology before bringing it to the marketplace. Data presentation and archiving is an important issue that, although it is being addressed today, still has future implications as the amount of data increase. Finally, we must not forget the importance of our ultimate goal of helping families to have healthy, happy offspring.

[An investigation and design of apparatus for measuring fetal lung maturity].

Clinically, the authorized method for determing fetal lung maturity is the measurement of the ratio of surface-active L/S in amniotic fluid. To set up new, simple, rapid and accurate method, an apparatus for measuring fetal lung maturity was made. The paper describes the basic principle and working procedure of the apparatus. 148 amniotic fluid specimens from different pregnancies were measured by means of the apparatus. The result was compared with the L/S. The sensitivity of measurement was 95%, specificity 91%, and accuracy 93%. The operation of the apparatus is simple, convenient and rapid. A small quantity of amniotic fluid is needed. In conclusion, the expected result was attained. The apparatus is of great importance to clinical application.

A new method of infant monitoring: for use at home and hospital.

AIM: To test a New Zealand originated, designed and funded remote infant heart rate monitor in the home and hospital settings (temporarily named the King Monitor) for accuracy and reliability. METHODS: The units were pretested using ECG simulators and on infants already being monitored in the neonatal unit. Longer term trials on hospital infants and infants being simultaneously monitored at home were then conducted. RESULTS: Interference and electrode problems were corrected during the pretesting phase. The unit worked accurately when compared with the standard neonatal heart and respiratory rate monitor in hospital and appeared in some infants to give earlier warning of problems than the standard home apnoea monitor. CONCLUSION: This simple to use monitor worked reliably and accurately under a wide variety of settings and with varying sized infants. In addition, the lack of direct connection between the infant and the control unit allowed freedom of movement of normal infants around the cot or bassinet. The monitor will require to be adapted for portable use at home and during travel.

Perinatal research and its support. Corporate contributions at McGill University.

Three technologic projects with potentially patentable end results are slowly evolving in the Department of Obstetrics and Gynecology, McGill University and Royal Victoria Hospital. A tax shelter infusion of a significant amount of venture capital developed opportunities for all three projects over two years. The three projects--fetal heart rate tracing analysis related to fetal outcome, a distributed and intelligent data acquisition system and selected ultrasonic three dimensional imaging--were advanced considerably, and their results are expressed in outline. The effects of such infusions of business support into an environment of sparse research grant support have been extremely encouraging to the investigators, but the department, with its obligations of ongoing research, teaching and patient care, must develop the next steps with care, although one of the projects has been extended by an interested corporation.

Application of the Gosset icterometer to screen for clinically significant hyperbilirubinemia in premature infants.

To evaluate the ability of the Gosset icterometer to identify the need for serum bilirubin measurement in premature infants we compared 269 icterometer readings with simultaneous serum bilirubin determinations in 90 premature infants of < 37 completed weeks of gestation. The relationship between serum bilirubin and icterometer values was different from that described in term infants. Mean serum bilirubin concentrations were lower at each icterometer level in premature infants than those reported in term babies. Neither interobserver variability nor the color balance of ambient light affected icterometry. Bilirubin estimates by first-time users were slightly less accurate than those made by experienced users. The icterometer provides reliable, cost-effective screening for clinically important hyperbilirubinemia in premature babies if a calibration curve specific for those infants is used. This simple device performs as well as electronic bilirubin meters when it is used in this manner.

The evaporimeter and emotional sweating in the neonate.

Emotional sweating from the palm of the hand occurs from birth in the term infant and can be conveniently measured with a skin evaporimeter. Such measurements provide objective information about an infant's state of arousal that might be useful to neonatologists and psychologists who are interested in studying stress and its modification in the newborn.

Measurements of transepidermal water loss in newborn infants.

Measurement of transepidermal water loss without disturbing the microclimate in the air layers above the skin has not been possible with previously available methods. The introduction of a new instrument, the Evaporimeter, for measuring the vapor pressure gradient above the skin surface meant that the evaporation of water from the skin could be determined. Each measurement is of short duration, and measurements can be made even in the most preterm infants under the conditions in which they are normally nursed. Studies of the evaporation rate and transepidermal water loss by this technique have increased our knowledge considerably during the last ten years. It is now well established that the loss of water from the skin surface is related to the ambient humidity, gestational age at birth, and postnatal age, and to weight, activity, and body temperature, and that it differs between appropriate- and small-for-gestational-age infants. Conclusions of special clinical importance drawn from these studies are that the most preterm infants may lose as much as 13 per cent of their body weight as TEWL during their first day after birth even at an ambient humidity of 50 per cent, and much more at a lower ambient humidity, and that their losses gradually diminish with age but are of significance even four weeks after birth. Small-for-gestational-age infants have a lower TEWL early after birth than appropriate-for-gestational-age infants. For heat exchange between the infant and its environment, TEWL plays an important role. In preterm infants, losses of heat through evaporation are very high early after birth. On the other hand, their heat losses through other routes are smaller because of the high ambient temperature in which they have be nursed in order to maintain a stable and normal body temperature. Simultaneous measurements of evaporation rate and skin blood flow have shown that the skin blood flow increases at a lower body temperature than the evaporation rate and that not all full-term infants sweat in a warm environment even when their body temperature becomes higher than 37.2 degrees C, which may indicate a delay in the postnatal adaptation of heat regulation. In addition, this regulation can easily be disturbed by a central cold-stimulation in infants who react with sweating in a warm environment.

Fetal razor: an aid for scalp sampling.

Scalp sampling to evaluate fetal acid-base status was introduced 20 years ago. In most instances, adequate samples may be obtained without difficulty. Occasionally, however, a region of scalp free of hair cannot be found. As a result, the sample either diffuses along the hairs that are present or clots. Although a "fetal razor" has been incorporated into the kits that are utilized to apply pO2 electrodes to the fetal scalp, none has been devised for routine fetal scalp sampling. We report the modification of a single or double-edged razor for this specific purpose.

Maternal transport.

Maternal transport offers the following distinct advantages over newborn transport: 1. The mother at risk may receive the highest level of obstetric expertise and technology available in the area. 2. The newborn is assured of immediate intensive paediatric evaluation and support. 3. The reduced equipment needs increase the speed and efficiency of the transport operation. 4. Mother-infant bonding may be enhanced. Maternal transport can never replace newborn transport for there will always be unexpected deliveries of compromised or malformed infants. Thus, in an effective regional perinatal care system, obstetric and neonatal transport programmes should complement each other. Experience to date would indicate that, when such efforts are co-ordinated, one can expect a further decline in perinatal morbidity and mortality for the region.